Volunteer In-take Form
S.O.Y. (Saving Our Youth) Program
VieGenix Health Education Foundation
Email *
Full Name *
Date of Birth *
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Address *
City *
State *
Zip Code *
Phone Number *
Email *
Emergency Contact Name *
Emergency Contact Phone *
Relationship *

Volunteer Interests

Why are you interested in volunteering with the S.O.Y. program?

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What areas would you like to get involved in? (Check all that apply) *
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Availability
Please indicate the days and times you are available to volunteer:   *

Skills & Experience
Please list any relevant skills, certifications, or experience you bring to this volunteer opportunity:

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  Do you have any prior experience working with youth?  
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If yes, please explain: *

Background Information

Have you ever been convicted of a crime, including a felony or misdemeanor?

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If yes, please explain or type N/A: *
Do you have any conditions (physical or otherwise) that may affect your ability to perform volunteer duties?  
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If yes, please explain or type N/A:
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Consent and Acknowledgment

I, _________________________ (print name), hereby acknowledge that as a volunteer for the S.O.Y. (Saving Our Youth) Program under the VieGenix Health Education Foundation, I may be required to undergo a background check and/or drug testing as a condition of volunteering.

I understand that the background check will include a review of my criminal history, and that drug testing may involve the screening for illegal substances in compliance with the foundation’s policies. By signing below, I provide my consent for VieGenix Health Education Foundation to conduct these screenings and acknowledge that the results may impact my eligibility to participate as a volunteer.

I also understand that all personal information collected through this form will be treated confidentially and used solely for the purposes of determining my suitability for this volunteer opportunity.

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Volunteer Consent
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Required
I understand that this form does not automatically make me a volunteer. Paperwork would need to be completed as well as successfully passing my drug test and background check. *
Required
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